Preliteracy Skills in Young Children Who are Deaf/Hard of Hearing: Secondary Analysis of the Technology-assisted Language Intervention Randomized Trials

Abstract

Objectives: Most children exhibit preliteracy skills by preschool. Children who are deaf/hard of hearing (DHH) with a language gap are at risk for delayed preliteracy skills. Our study aimed to describe preliteracy skill development in preschool-aged DHH children and investigate associated factors.

Methods: Children, aged 3 to 5 years, were included in the analysis if enrolled in randomized trials of a language intervention using augmentative and alternative communication, shown to boost language skills. Evaluations using the Clinical Evaluations of Fundamentals-Preschool Preliteracy Rating Scale (PRS) were conducted at baseline, 24 weeks, and 48 weeks. Repeated-measures models assessed changes in total PRS scores and Early Reading and Early Writing subdomains. Results were presented as least square mean values with 95% confidence intervals.

Results: Forty-five children had completed pre-data and post-data. The mean nonverbal IQ was 99.3 (SD 14.3), and receptive and expressive language were 82.3 (14.9) and 76.8 (17.0), respectively. Significant (p < 0.0001) skill growth was observed with all preliteracy outcomes, ranging from 11 to 15 points in the first 24 weeks. Increasing receptive and expressive language over time was significantly associated with increasing scores. Factors such as aided hearing thresholds, caregiver education level, and hearing device use were not significant in models.

Conclusion: Language is essential for literacy development. Language-enhancing interventions could facilitate literacy skills. Monitoring preliteracy skills in DHH children is crucial, given their increased risk for language delays. Further research is needed to support early literacy development in this population, ensuring they have the tools they need for future success.

Trial registration: ClinicalTrials.gov NCT02998164.

Keywords: deaf and hard of hearing; language; preliteracy skills.

Figure 1.

Least square means with 95% CIs (error bars) for the total Preliteracy Rating Scale (PRS) and the subdomains of Early Reading and Early Writing at baseline, 24 weeks, and 48 weeks for DHH children with language gaps. Models were adjusted for expressive language levels, Shift subscale of the BRIEF-P, and annual household income. Children with no language gaps are included as a reference (bars with hash marks).